Serum alkaline phosphatase ALP is a marker of vascular calcification. A high serum ALP level is associated with an increase in cardiovascular events, and predicts poor functional outcome in patients with stroke. We investigated whether serum ALP was associated with cerebral small vessel disease cSVD and large cerebral artery stenosis LCAS.

Subjects with SLI odds ratio OR: 2.09; 95% confidence interval CI: 1.27–3.42; p = 0.004 and MS-cWMH OR: 1.48; 95% CI; 1.03–2.13, p = 0.036 were significantly more likely to have ALP levels in the third tertile ALP ≥ 195 IU-L than the first tertile ALP ≤ 155 IU-L, after adjusting for cardiovascular risk factors. The mean serum ALP level was significantly higher in patients with SLI or MS-cWMH compared to patients without those findings. After adjustment for confounding factors, the multivariate model found that the statistical significance of serum ALP remained when the presence of SLI OR: 1.05 per 10 IU-L increase in ALP; 95% CI: 1.02–1.08; p = 0.003 or MS-cWMH OR: 1.03 per 10 IU-L increase in ALP; 95% CI: 1.00–1.06; p = 0.025 were added to the model. There were no differences in the proportions of patients with LCAS, ICAS, and ECAS across the serum ALP tertiles.

Conclusions

Our study of neurologically healthy participants found a positive association between serum ALP level and indicators of cSVD, but no association between serum ALP level and the indicators of LCAS.